Section of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana 46202-5123, USA.
Ann Thorac Surg. 2010 Feb;89(2):556-62; discussion 562-3. doi: 10.1016/j.athoracsur.2009.10.050.
Construction of a total cavopulmonary anastomosis using an intra-atrial lateral tunnel Fontan (LTF) is known to yield good early and midterm results. Given the current controversy regarding indications for a total extracardiac conduit Fontan, we reviewed the long-term outcomes after a LTF operation and compared them with recently published series using one or both techniques.
Between 1992 and 2008, 220 of 280 patients (median age, 2.5 years; range, 1 to 45) with a wide range of underlying diagnoses underwent a fenestrated or nonfenestrated LTF operation at our institution. Current follow-up information was available for 215 patients (98%; mean follow-up, 6.7 +/- 3.9 years). Risk factor analysis included patient-related and procedure-related variables, with death, failure (takedown or transplantation), and bradyarrhythmia or tachyarrhythmia as outcome variables.
There was 1 early death, 10 late deaths, 3 takedown operations, and 1 heart transplantation. Kaplan-Meier estimated survival was 96% at 5 years and 95% at 10 and 15 years, and freedom from failure was 94% at 5 years and 93% at 10 years. Freedom from new supraventricular tachyarrhythmia was 98% at 5 years and 95% at 10 years; freedom from new bradyarrhythmia was 97% at 5 years and 96% at 10 years. Six patients have protein-losing enteropathy, and 2 of 6 have had Fontan takedown. Multivariable risk factors for development of supraventricular tachyarrhythmia included atrioventricular valve abnormalities (p = 0.02), and preoperative bradyarrhythmia (p = 0.01). Risk factors for bradyarrhythmia included the need for early postoperative pacing (p = 0.001). None of the patient-related variables significantly influenced survival.
The LTF operation results in excellent midterm outcome even when used in patients with complex anatomy. The incidence of postoperative atrial tachyarrhythmia is low and depends largely on the underlying cardiac morphology and incidence of preoperative arrhythmia. The good midterm outcome after a LTF operation should serve as a basis for comparison with other surgical alternatives to complete the Fontan circulation.
使用心房间侧隧道 Fontan（LTF）构建全腔肺吻合术，其早期和中期结果良好。鉴于目前对全体外循环管道 Fontan 的适应证存在争议，我们回顾了 LTF 手术后的长期结果，并将其与最近发表的使用一种或两种技术的系列研究进行了比较。
1992 年至 2008 年间，我们机构为 280 例患者中的 220 例（中位年龄 2.5 岁；范围 1 至 45 岁）进行了开窗或非开窗 LTF 手术，这些患者有广泛的基础诊断。目前可获得 215 例患者的随访信息（98%；平均随访 6.7±3.9 年）。风险因素分析包括患者相关和手术相关变量，以死亡、失败（拆除或移植）和心动过缓或心动过速作为结局变量。
早期死亡 1 例，晚期死亡 10 例，拆除手术 3 例，心脏移植 1 例。Kaplan-Meier 估计 5 年生存率为 96%，10 年和 15 年生存率为 95%，5 年无失败生存率为 94%，10 年无失败生存率为 93%。5 年时新发房性心动过速的无发生率为 98%，10 年时为 95%；5 年时新发心动过缓的无发生率为 97%，10 年时为 96%。6 例患者有蛋白丢失性肠病，其中 2 例 Fontan 拆除。发生房性心动过速的多变量危险因素包括房室瓣异常（p=0.02）和术前心动过缓（p=0.01）。心动过缓的危险因素包括需要术后早期起搏（p=0.001）。患者相关变量无一显著影响生存率。
即使在解剖结构复杂的患者中，LTF 手术也能获得良好的中期结果。术后房性心动过速的发生率较低，主要取决于基础心脏形态和术前心律失常的发生率。LTF 手术后的良好中期结果应为与其他手术选择比较的基础，以完成 Fontan 循环。
Zotero 插件